<div id="goodsModal" method="post" action="__ACTION__?goods_id={$goods_id}" class="modal modal-small hide fade" tabindex="-1" role="dialog" aria-hidden="true">
<form method="post" action="__ACTION__" data-validate="true" data-submit="ajax" class="form-horizontal">
  <div class="modal-header">
    <button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button>
    <h3>编辑</h3>
  </div>
	  <div class="modal-body">
	  	<input type="hidden" name="id" value="{$data.id}">
		<div class="control-group">
			<label class="control-label must">退货联系人</label>
			<div class="controls">
				<input type="text"  name="receiver_name" value="{$data.receiver_name}" placeholder="" maxlength="15" required="required">
			</div>
		</div>
		<div class="control-group">
			<label class="control-label must">退货电话</label>
			<div class="controls">
				<input type="text" class="required number" name="receiver_mobile" value="{$data.receiver_mobile}" placeholder="" maxlength="15" required="required">
			</div>
		</div>
		<div class="control-group">
			<label class="control-label must">退货邮编</label>
			<div class="controls">
				<input class="required number" type="text" name="receiver_zip" value="{$data.receiver_zip}" placeholder="" minlength="6"  maxlength="6" required="required">
			</div>
		</div>
		<div class="control-group">
				<label class="control-label must">退货地址</label>
				<div class="controls">
					<select required="required" name="receiver_province" id="province_id" data-city="#city_id" data-selected="{$data.receiver_province}" style="width:78px;">
						<option value="">请选择</option>
					</select>
					<select required="required" name="receiver_city" id="city_id" data-county="#county_id" data-selected="{$data.receiver_city}" style="width:78px;">
					<option value="">请选择</option></select>
					<select required="required" name="receiver_county" id="county_id"  data-selected="{$data.receiver_county}" style="width:78px;"><option value="">请选择</option></select>
				</div>
		</div>
		<div class="control-group">
			<label class="control-label must">详细地址</label>
			<div class="controls">
				<input type="text" name="receiver_detail" value="{$data.receiver_detail}" placeholder="" maxlength="15" required="required">
			</div>
		</div>
	  </div>
	  <div class="modal-footer">
	  	<button type="button" class="btn" data-dismiss="modal" aria-hidden="true">关闭</button>
	  	<button type="submit" class="btn btn-primary" aria-hidden="true">保存</button>
	  </div>
</form>
	<script src="/js/address.js"></script>
	<script type="text/javascript">
		Address.bind("#province_id");
	</script>
</div>